Summary: Opioid addiction and related deaths have considerably impacted average life expectancy in the US. It has emerged as a major preventable cause of mortality. This addiction has been fueled by the over-prescription of opioids to control pain. Thus, many states started limiting the prescription of opioids, and New Jersey was the first state to do so. Unfortunately, it appears that limiting prescriptions at this stage is not helping, and it is rather causing even greater mortality. It is because those addicted to opioids continue to use these drugs by procuring illicit opioids. Thus, data from New Jersey shows that a decline of 35% in prescriptions resulted in the tripling of overdose-related deaths in the state.
The US is among the few developed nations experiencing a decline in life expectancy since 2015. Moreover, such a decline has started after more than a century of an upward trend. It is worrisome, as the US is among the global leaders when it comes to healthcare spending. Many believe that this decline, at least partially, has occurred due to opioid overdose-related deaths1 highlighting the urgent need for effective opioid addiction treatment.
Data shows that deaths from opioid overdose have quadrupled in the last 20 years in the US. Thus, in 2019, drug overdose resulted in more than 70000 deaths, and among them, more than 70% were due to opioid overdose2.
Many of these deaths occur among individuals who were earlier prescribed opioids for their painful conditions. However, many of them got addicted and continued their use. With many such opioids bought illicitly.
Many US states have responded to this epidemic by limiting opioid prescriptions. However, data indicates that it may not be the best way to tackle this epidemic.
Opioid overdoses continue to rise in New Jersey despite the limits on their prescription
New Jersey became the first state in the US to limit the prescription of opioids to 5-days for severe pain. Thus, if someone needs to take opioids for a longer time, they would need to get a new prescription each time. These measures were meant to discourage the prolonged use of opioids.
However, experts doubt that the measure is working. It appears that many would instead buy illegal opioids or may even start using street drugs to manage their health condition.
The new study shows that the risk of opioid overdose has more than tripled from 2014 to 2019 among Medicaid beneficiaries. Thus, it rose from 120.5 per 100 000 person-years to 426.8. That is a considerable rise. Moreover, it appears that this prescription limit especially led to the increased penetration of fentanyl. For example, data shows that portions of fentanyl seizures among heroin seizures rose from 2% to 80% within the same period3.
This increase primarily involved the overdose of heroin and synthetic opioids. Further, it was associated with increased risk of alcohol abuse, non-opioid drugs use, depression, and increased risk of blood-borne diseases like hepatitis C.
Experts agree that although the initial opioid epidemic has been fueled by over prescriptions of these drugs. However, it appears that limiting their prescription at this stage does not appear to be helpful. On the contrary, it rather increases the risk of people using more illicit drugs and exposing themselves to certain infections.
The present study shows that since 2015, there has been a decline of 35% in opioid prescribing. Unfortunately, at the same time, there has been an alarming increase in overdose-related deaths, especially those associated with illicit fentanyl use.
Further, researchers suggest that there is a considerable need to pay attention to the overdose survivors, as these are individuals living with multiple disorders. Data from 2019 shows that half of such cases had major depression, and about 39% were living with alcohol abuse. Other common comorbidities include high rates of hepatitis C, bipolar disorders, cannabis abuse, sedative use, and schizophrenia.
Additionally, the study’s authors noticed that various other US states have also limited the prescriptions of opioids. This has resulted in the biggest decline in opioid prescriptions in the last 20 years. Nonetheless, overdose-related deaths are increasing each year considerably, with 93 000 deaths reported in 2020. Moreover, the majority of these deaths were linked to illicit fentanyl and other opioids.
References
1. DeWeerdt S. Tracing the US opioid crisis to its roots. Nature. 2019;573(7773):S10-S12. doi:10.1038/d41586-019-02686-2
2. Understanding the Epidemic | CDC’s Response to the Opioid Overdose Epidemic | CDC. Published October 2, 2021. Accessed November 9, 2021. https://www.cdc.gov/opioids/basics/epidemic.html
3. Crystal S, Nowels M, Olfson M, Samples H, Williams AR, Treitler P. Medically treated opioid overdoses among New Jersey Medicaid beneficiaries: Rapid growth and complex comorbidity amid growing fentanyl penetration. Journal of Substance Abuse Treatment. 2021;0(0). doi:10.1016/j.jsat.2021.108546
